Friday, June 23, 2006

More on CDS

Earlier in the week, I wrote about Clinical Decision Support (CDS) on Hospital Impact. Recently the American Medical Informatics Association (AMIA) released a roadmap for the nation-wide implementation of CDS. I find this roadmap intriguing and I immediately wanted to explore the intersection between CDS and Evidence Based Medicine (EBM)

First, let’s define the terms:

Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care (from AMIA roadmap).

Evidence Based Medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (from Health Affairs).

If it isn’t evident from the definition, CDS is a primarily a process that is mediated by technology. The big question with CDS is how you get the right information to the right people at the right time. EBM, in one sense, is an activity that could be accomplished through CDS, but EBM can be much more than that. From my understanding EBM can be as simple as a healthcare provider using clinical research to influence a care decision. In this sense, EBM is more equivalent to CDS. But my experience with EBM also includes larger, more organizational practices, such as the implementation of clinical practice guidelines (presumably derived from clinical research). Implementing clinical guidelines is more than a technological process; it involves collaboration among physicians and nurses and the creation of monitoring and measurement processes. So CDS may assist in portions of the implementation of clinical guidelines (the identification of better-practices, the collection of clinical evidence, and the distribution of this information), but it does not necessarily provide for the entire process.

All of this to say that CDS and EBM do cross paths. Where they do cross, there will likely be applications developed that facilitate EBM. Where the two diverge is, in my opinion, fertile ground for innovation.

Wednesday, June 14, 2006

122,000 Lives Saved!

Splash it across the newspapers and proclaim it from the rooftops: Healthcare has its most significant achievement in years, perhaps ever. Today, Donald Berwick, President and CEO of the Institute for Healthcare Improvement (IHI), announced the results of an 18 month campaign to save 100K lives, through the implementation of IHI’s set of six patient safety practices. Over 3,100 hospitals joined the effort and in the end, they saved an estimated 122,300 lives.

I realize that I have blogged about this in the past, but I do think that this has been a remarkable campaign. To get 60% of the nations hospitals to participate in a single, focused endeavor without a financial incentive is quite a feat. I attribute this to Dr. Berwick’s clarity of vision, commitment to action, and the sustained “positive-ness” of the campaign. A ton of work also went into providing education and guidance for participating hospitals.

I am also very pleased that Dr. Berwick is carrying on the momentum by announcing the next campaign to encourage participating hospitals to adopt all of the patient safety practices (50% of the hospitals had only implemented 3 of the 6 practices). My hope is that the IHI will identify new patient safety practices and use this campaign model to foster their adoption across the industry.

With all of the negative public sentiment around the need to “fix healthcare,” this campaign makes me proud to be a part of the industry.

Wednesday, June 07, 2006

My Own Medicine

It seems that the ultimate test of any advice giver is the willingness to take his own. I am happy to announce that I am, however carefully, following my advice and venturing out to purchase health insurance for myself and my family on my own. I have opined on the need for healthcare consumers to take more responsibility for the cost of their healthcare expenditures, not for only for cost-cutting reasons, but more so to increase their sense of ownership for their own health.

So what brought about this adventure in risk balancing? With 2 young children, we are relatively frequent users of low-level medical services, like doctor’s visits and short-term prescriptions. We have enjoyed a number of years almost no cost HMO coverage, so we were a little shocked when we had to pick up the entire premium for my wife and kids with my new job. The time came to rebalance our risk equation. Premium payments were just too high. Yes, we use services, but we decided that we would rather pay full price for periodic services rather than give a big part of our paycheck to the insurance company. With all of this in mind, we chose a high deductible plan with a low monthly premium. We didn’t go all the way for a HSA, but maybe next year….

So we definitely feel like we are taking on more risk with the high deductible plan. Will it change our utilization? I can certainly see how we might wait that extra day to see if the sniffles and sore throat clear up on its own, but we are certainly planning to put that extra money away for times when there is no question that we need medical care. Interestingly, we have already started talking about ways that we can keep ourselves healthy.

Will the risk/reward pay off in the end? Only time will tell.